| NPI | 1912984303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LA0401X Anesthesiology, Addiction Medicine (Licence: FL ME56258) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME0056258) |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2011-04-28 |